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Job Address 2 1 Waqhi notnn t-rerst-[Port of Stockto j City Stockton Application is hereby made to San Joaquin County for a permit to construct and/or install the work her 4é This application is made in comPliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regiile4ic,pg San Joaquin County Public Health Services. Lot Size/Acreage 600 acre SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ^ '- ENVIRONMENTAL HEALTH DIVISION 1601 E. HAZELTON AVE., PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 40 C'ce:ILI"ii• Ao 34 . 6' 4',/ ,v4,!,:' //-, t) <7 PERMIT EXPIRES 1 YEAR FROM DATE I SSUED 4-/; (i (Complete in Triplicate) '4f,z-4////,41/• "".tli 'll.:// ' ';ir" ,-‘90,1 APPLICATION FOR PERMIT 9 - - - 720 East "E" Street, P.O.Box 547 Owner's Name R1113( Terri 1-1, 1.S Address WI lmi ngi-np CA q07 4R Phone 2L) A16-600 _11-i , .( 1202 Kentucky Ave. Contractor laL;ter DeNre 1 pment Cnrr License No. 283326 Address.-- Woodland, CA 95695 Rhone (916) 662-28 TYPE OF WELL/PUMP: NEW WELL 0 WELL REPLACEMENT E DESTRUCTION El Out of Service Well 0 PUMP INSTALLATION 0 SYSTEM REPAIR CI OTHER 0 Monitoring Well El DISTANCE TO NEAREST: SEPTIC TANK N/A SEWER LINES N/A DISPOSAL FLD. N/A PROP. LINE N/A FOUNDATION N../A AGRICULTURE WELL N/A OTHER WELL N/A PITS/SUMPS N/A INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS D Industrial 0 Open Bottom 0 Manteca Dia. of Well Excavation 10 inches Dia. of Well Casing 4 in. I .D [1 Domestic/Private i1 Ceavel Pack 0 Tracy Type of Casing P V .C. Specifications Srh 4n I'l Public n Other Ii Delta Depth of Grout Seal ± 3 feet Type of GroutBentOnite/Cem< _ i I Initiation ±20L Approx. Depth I I Eastern SurfaceSeallnstalledbyWater Develpment Corp. Repair Work Done L3 Type of Pump None H.P. N/A State Work Done Install 4 monitoring vv( Well Destruction 0 Well Diameter 4inch I .D . Sealing Material & Depth 2 ft. of bentonite pellets Depth ± 20' Filler Material & Depth #3 Sand —approx. 6 to 20 Ft. b .g .s . TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted if public sewer is available within 200 feet.) Installation will serve: 2N4LA Commercial Other ,Residence Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK 0 Type/Mfg Capacity No. Compartments PKG. TREATMENT PIT. 0 Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE CI No. & Length of lines N/A Total length/size FILTER BED 0 Distance to nearest: Well Foundation Property Line SEEPAGE PITS I I Depth N/A Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS 0 a. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, an rules and regulations of the San Joaquin County Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ persons subject to workman's compensa- tion laws of California." ap Signed :11) u t call for all requir d inspections. Complete drawing on reverse side. Title' Project Geologist Date. 8/1/91 DEPARTMENT USE ONLY Date Pit or Grout Inspection by Date Final Inspection by Additional Comments: Applicant — Return all copies to: San Joaquin County Public Health Services, Environmental Health Permit/Services 1601 E. Hazelton Ave. P 0 Box 2009, Stockton, CA 95201 Application Accepted by nt 11 9) EH 13-24 (REV. I Eli',4-21111 FEE INFO 011 AMOUNT AMOUNT DUE AMOUNT REMITTED CK i CASH RECEIVED BY DATE PERMIT NO. fil(c?7, (Wt30